Leadership for Health System Transformation Principles, Practices and a Christian Perspective Henry Mosley Presented at the CCIH Conference May 26, 2007

Leadership in the Bible Name some great leaders in the Bible from the Old Testament What are some of the character traits that made these Biblical heroes leaders? What did they do that made them leaders?

What Do Leaders Do? Generate a Shared Vision Enable Others to Act Create Learning Organizations How does the life of Jesus serve as a model for leadership?

Background Johns Hopkins Leadership Seminars - “Strategic Leadership for Health System Transformation in Developing Countries” Developed by Ben Lozare and Henry Mosley and presented worldwide since 1998

Our Key Reference Book The Fifth Discipline. The Art and Practice of the Learning Organization Peter Senge First edition published by Currency Doubleday, NY, Revised edition, 2006

What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

Strategic Thinking, Action and Reflection Guide A model of leadership development based on Peter Senge’s Five Learning Disciplines starguide/begin.swf starguide/begin.swf starguide/begin.swf STARGuide

What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

Core Leadership Disciplines* Systems Thinking Personal Mastery Mental Models Shared Vision Mental Models *Ref. Peter Senge (1990)

The STAR Framework Strategic Thinking, Action and Reflection

Systems Thinking “Systems thinking is a conceptual framework, a body of knowledge and tools that has been developed over the past 50 years to make full patterns clearer and to help us see how to change them effectively.” Senge (1990), p7

Systems Thinking – STAR Question How can we see the dynamics, interconnections, deeper patterns and purposes of systems?

Personal Mastery Personal mastery is the discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively. Senge (1990), p. 7

Personal Mastery – STAR Question How can we live more creative and purposeful lives?

Mental Models Mental models are deeply ingrained assumptions, generalizations, or even pictures or images that influence how we understand the world and how we take action. Senge (1990), p.8

Mental Models – STAR Question How can we continuously open our minds to new ideas?

Shared Vision If any one idea about leadership has inspired organizations for thousands of years, it’s the capacity to hold a shared picture of the future we seek to create….The practice of shared vision involves the skills of unearthing shared “pictures of the future” that foster genuine commitment and enrollment rather than compliance. Senge (1990), p. 9

Shared Vision – STAR Question How can we inspire others to seek goals “beyond imagination”?

Where do leaders operate? Beyond Imagination That’s Impossible Looks Difficult Easy to do

Team Learning When teams are truly learning, not only are they producing extraordinary results, but the individuals are growing more rapidly than could have occurred otherwise. The discipline of team learning starts with “dialogue,” the capacity of members of a team to suspend assumptions and enter into genuine “thinking together”. To the Greeks, dia-logos meant a free-flowing of meaning through a group, allowing the group to discover insights not attainable individually. Senge, p. 10

Team Learning – STAR Question How can we align everyone to learn together how to reach a shared vision?

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What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

A Leader is a Catalyst for Change The Learning Organization is the Instrument of Change

Learning Organizations In a learning organization, leaders are designers, stewards, and teachers. They are responsible for building organizations where people continually expand their capabilities to understand complexity, clarify vision and improve shared mental models – that is, they are responsible for learning….the first leadership act [is] inspiring (literally “to breath life into”) the vision of learning organizations. (author’s italics) Senge (1990), p. 340

The Leader as Designer “The first task of organizational design concerns designing the governing ideas – the purpose, vision, and core values by which people will live” Bill Bradley, President and CEO, Hanover Insurance Senge (1990), p. 344.

The Leader as Steward “The leader’s purpose story…brings a unique depth of meaning to his vision…this story is central to his ability to lead. It places his organization’s purpose, its reason for being within a context of “where we’ve come from and where we’re headed,” where the “we” goes beyond the organization itself to humankind more broadly. (continued)

The Leader as Steward (continued) “ Out of this deeper story and sense of purpose or destiny, the leader develops a unique relationship to his or her own personal vision. He or she becomes a steward of the vision….Being a steward of a vision shifts a leader’s relationship toward her or his personal vision. It ceases to be a possession, as in “this is my vision” and becomes a calling. You are “its” as much as it is yours. Senge (1990), p. 346

The Leader as Teacher Leaders can influence people to view reality at four distinct levels: events, patterns of behavior, systemic structures, and a “purpose story”….By focusing on the “purpose story” – the larger explanation of why the organization exists and where it is trying to head – leaders add an additional dimension of meaning. (continued)

The Leader as Teacher (continued) When people throughout an organization come to share a larger sense of purpose, they are united in a common destiny. They have a sense of continuity and identity not achievable in any other way. Senge (1990), p. 354

What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

Government Households Community Household Production of Health Framework Global driving forces Health

What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

Resources Values Practices Organizational Capabilities - Values, Practices and Resources.

All parts of the health system operate through values, practices and resources Global driving forces Values Practices Resources Households Values Practices Resources Community Values Practices Resources Government Health

What are the five frameworks that we use in our leadership seminars? 1.The STAR Leadership Disciplines 2.The Learning Organization 3.The Household Production of Health 4.Organizational Capabilities 5.The Guide for Action Learning

Interest groups Policymakers, planners Managers, providers Communities, households MIS Evaluations Research, pilot projects The top–down, or “blueprint” intervention strategy disconnects learning from action Health LearningAction

Policymakers, planners Managers, providers Communities, households Needs Tasks Outputs Competencies Demand Decisions The “Learning Organization” strategy will link knowledge to action Interest groups Learning Health

Learning Organizations The first challenge is sustained effort….since the practice [of the disciplines] goes on forever. In building learning organizations, there is no “there,” no ultimate destination, only a lifelong journey. Letting go of “the learning organization” as the ultimate state to be achieved is very difficult for us goal-oriented Westerners....building learning organizations entails profound cultural shifts. Senge (1990), p. xv

The Guide Framework

The Guide Framework - Questions 1. What is the future that we want to create? 2. What is happening now? 3. Why is there a difference? 4. What do we need to change? 5. How do we nurture change and accountability?

What we have learned about leadership Leadership development is a life-long, non- linear process. Being a leader is a dynamic condition that changes constantly. Leadership is not a position or role. It is who we are, what we know, and what we do. We need to nurture leadership at all levels, not just at the top!

What is our leadership seminar’s key idea? What is our leadership seminar’s key idea? We need to nurture a learning organization where continuous learning is a passion, where everyone shares a vision and feels enabled to achieve desired health outcomes.

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